Systems of Care Implications in Hawai'i: Sexual and Gender Minorities.

Sexual and gender minorities (SGM) are diverse groups of people who do not identify as heterosexual or cisgender. SGM communities include Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals as well as people of other sexual orientations and gender identities. SGM communities are disproportionately affected by substance use disorders, with differential use of specific substances among persons based on sexual or gender identity. As understood through the minority stress model, substance use and misuse among SGM people are tied to risk and resiliency factors at all levels of the social ecological paradigm. Despite the disproportionate burden of substance use disorders on SGM people in Hawai'i, very few resources or programs exist to ameliorate the impact of substance use on this community. Although some models of care could be useful for SGM people, community-specific interventions are scarce, especially in Hawai'i. To successfully meet the needs of SGM people in Hawai'i, multi-level transformation of the substance use prevention and treatment landscape must address: culturally appropriate service delivery; workforce recruitment and development; nimble and adequate financing; consistent data collection and reporting; and systems-level policy updates.

Influence of aromatase inhibition on the bone-protective effects of testosterone.

The influence of the aromatase enzyme in androgen-induced bone maintenance after skeletal maturity remains somewhat unclear. Our purpose was to determine whether aromatase activity is essential to androgen-induced bone maintenance. Ten-month-old male Fisher 344 rats (n = 73) were randomly assigned to receive Sham surgery, orchiectomy (ORX), ORX + anastrozole (AN; aromatase inhibitor), ORX + testosterone-enanthate (TE, 7.0 mg/wk), ORX + TE + AN, ORX + trenbolone-enanthate (TREN; nonaromatizable, nonestrogenic testosterone analogue; 1.0 mg/wk), or ORX + TREN + AN. ORX animals exhibited histomorphometric indices of high-turnover osteopenia and reduced cancellous bone volume compared with Shams. Both TE and TREN administration suppressed cancellous bone turnover similarly and fully prevented ORX-induced cancellous bone loss. TE- and TREN-treated animals also exhibited greater femoral neck shear strength than ORX animals. AN co-administration slightly inhibited the suppression of bone resorption in TE-treated animals but did not alter TE-induced suppression of bone formation or the osteogenic effects of this androgen. In TREN-treated animals, AN co-administration produced no discernible effects on cancellous bone turnover or bone volume. ORX animals also exhibited reduced levator ani/bulbocavernosus (LABC) muscle mass and elevated visceral adiposity. In contrast, TE and TREN produced potent myotrophic effects in the LABC muscle and maintained fat mass at the level of Shams. AN co-administration did not alter androgen-induced effects on muscle or fat. In conclusion, androgens are able to induce direct effects on musculoskeletal and adipose tissue, independent of aromatase activity.

Community-led cancer action councils in Queens, New York: process evaluation of an innovative partnership with the Queens library system.

INTRODUCTION: Community-based participatory research (CBPR) has great potential to address cancer disparities, particularly in racially and ethnically diverse and underserved neighborhoods. The objective of this study was to conduct a process evaluation of an innovative academic-community partnership, Queens Library HealthLink, which aimed to reduce cancer disparities through neighborhood groups (Cancer Action Councils) that convened in public libraries in Queens, New York. METHODS: We used a mixed-methods approach to conduct 69 telephone survey interviews and 4 focus groups (15 participants) with Cancer Action Council members. We used 4 performance criteria to inform data collection: action or attention to sustainability, library support for the council, social cohesion and group leadership, and activity level. Focus group transcripts were independently coded and cross-checked for consensus until saturation was achieved. RESULTS: Members reported benefits and barriers to participation. Thirty-three original focus group transcript codes were organized into 8 main themes related to member experiences: 1) library as a needed resource, 2) library as a reputable and nondenominational institution, 3) value of library staff, 4) need for a HealthLink specialist, 5) generation of ideas and coordination of tasks, 6) participation challenges, 7) use of community connections, and 8) collaboration for sustainability. CONCLUSION: In response to the process evaluation, Cancer Action Council members and HealthLink staff incorporated member suggestions to improve council sustainability. The councils merged to increase intercouncil collaboration, and institutional changes were made in funding to sustain a HealthLink specialist beyond the grant period.

Testosterone dose dependently prevents bone and muscle loss in rodents after spinal cord injury.

Androgen administration protects against musculoskeletal deficits in models of sex-steroid deficiency and injury/disuse. It remains unknown, however, whether testosterone prevents bone loss accompanying spinal cord injury (SCI), a condition that results in a near universal occurrence of osteoporosis. Our primary purpose was to determine whether testosterone-enanthate (TE) attenuates hindlimb bone loss in a rodent moderate/severe contusion SCI model. Forty (n=10/group), 14 week old male Sprague-Dawley rats were randomized to receive: (1) Sham surgery (T9 laminectomy), (2) moderate/severe (250 kdyne) SCI, (3) SCI+Low-dose TE (2.0 mg/week), or (4) SCI+High-dose TE (7.0 mg/week). Twenty-one days post-injury, SCI animals exhibited a 77-85% reduction in hindlimb cancellous bone volume at the distal femur (measured via µCT) and proximal tibia (measured via histomorphometry), characterized by a >70% reduction in trabecular number, 13-27% reduction in trabecular thickness, and increased trabecular separation. A 57% reduction in cancellous volumetric bone mineral density (vBMD) at the distal femur and a 20% reduction in vBMD at the femoral neck were also observed. TE dose dependently prevented hindlimb bone loss after SCI, with high-dose TE fully preserving cancellous bone structural characteristics and vBMD at all skeletal sites examined. Animals receiving SCI also exhibited a 35% reduction in hindlimb weight bearing (triceps surae) muscle mass and a 22% reduction in sublesional non-weight bearing (levator ani/bulbocavernosus [LABC]) muscle mass, and reduced prostate mass. Both TE doses fully preserved LABC mass, while only high-dose TE ameliorated hindlimb muscle losses. TE also dose dependently increased prostate mass. Our findings provide the first evidence indicating that high-dose TE fully prevents hindlimb cancellous bone loss and concomitantly ameliorates muscle loss after SCI, while low-dose TE produces much less profound musculoskeletal benefit. Testosterone-induced prostate enlargement, however, represents a potential barrier to the clinical implementation of high-dose TE as a means of preserving musculoskeletal tissue after SCI.

Sustaining CBPR partnerships to address health disparities in times of economic instability.

In unstable economic environments, CBPR partnerships in underserved communities may face unanticipated obstacles that threaten success and sustainability. This report describes challenges experienced by HealthLink, a CBPR partnership to address cancer disparities in Queens, N.Y., and how HealthLink adapted. Recommendations for designing CBPR partnerships to overcome unexpected challenges are provided.

Patients from abroad becoming patients in everyday practice: torture survivors in primary care.

Since 1975, over 3.5 million refugees have resettled in the United States, many of whom have experienced some form of torture, and little data exists on their primary care needs. This is retrospective chart-review of sixty-one torture survivors in Denver, Colorado. The patients were predominantly from Africa, 88% experienced physical torture, 21% sexual torture. Medical conditions included: major depression (45%), PTSD (48%), anxiety (31%), insomnia (50%), hypertension (29%), dyslipidemia (6%), HIV (6%) and tuberculosis class 2-4 (32%). Physical torture increased rates of PTSD (OR 7.29; CI 1.81, 29.45) and insomnia (OR 5.08; CI 1.41, 18.34). Sexual torture increased rates of major depression (OR 5.44; CI 1.29, 22.99), PTSD (OR 8.24; CI 1.61, 42.18), and insomnia (OR 6.84; CI 1.34, 34.90). Somatic complaints were more frequent in those who had experienced sexual torture (P = 0.041). Torture survivors have complex primary care needs, requiring multidisciplinary treatment.

Knowledge and quality of life in female torture survivors.

BACKGROUND: Immigrant women represent disadvantaged and vulnerable members of the torture survivor population. They tend to be isolated and have negative coping strategies resulting in poor health and well-being. The purpose of this pilot study is to develop and evaluate an educational and interactive women's health-based programme using health promotion and empowerment strategies, with the intent of using the knowledge gained to contribute to an ongoing women's health programme. METHODS: A one-group pre-test to post-test design was used with weekly intervention sessions over six weeks, with final evaluation on week seven. Topics covered included nutrition, exercise, healthy cooking, medications, personal and dental hygiene, women's health, and birth control. Achievement tests for health-related knowledge were developed by the principal investigator to match the content of each session. Tests were given before and after the session on weeks one through six, and tests on all content modules were repeated one week after the conclusion of the programme. The short version of the World Health Organization quality of life scale (WHOQOL-BREF) was administered at the start of the first session and at the conclusion of the programme. FINDINGS: Participants' WHOQOL-BREF scores improved significantly from the beginning to the end of the programme. Improvements in achievement scores from pre to post test for each session and from pre-test to the follow-up test at the end of the programme were also statistically significant. Finally, the overall change from pre to post to follow-up achievement test scores was statistically significant. Observable changes in the women were also seen over the duration of the programme, adding confidence to the results and effectiveness of the intervention. IMPLICATIONS: Little is currently known about health-based interventions for the vulnerable population of female torture survivors. Public health nurses and other professionals who work with this population have a unique opportunity to influence behavior change and promote empowerment in this population. The techniques employed in this study can be used by public health nurses as a basis for designing women's health-based programmes at other torture treatment centres throughout the world.

Quantitative feedback versus standard training for cervical and thoracic manipulation.

OBJECTIVE: To quantify elements of spinal manipulation therapy performance and to test the strategy of combined rehearsal and quantitative feedback as a means of enhancing student skill development for cervical and thoracic manipulative procedures. DESIGN: Randomized, controlled study. SETTING: Chiropractic college. SUBJECTS: Thirty-nine chiropractic student volunteers entering the manipulation technique training course. METHODS: Student performance of cervical and thoracic spinal manipulation therapies were quantified at the beginning, middle, and end of a trimester using a Leader 900 Z series manipulation table (Leader International, Port Orchard, Wash) embedded with an AMTI force plate. Passive loads acting through the targeted (C2 or T7) functional spinal units were estimated using inverse dynamics. Participating students rehearsed the index transverse (C2) and single pisiform-transverse (T7) procedures following either the standard curriculum alone or a modified curriculum adding the Dynadjust Instrument training aid (Labarge, Inc.), as assigned on a randomized basis. Student t and chi-square tests were used to explore and describe biomechanical parameter changes over time as the semester progressed. RESULTS: Significant changes in performance between the standard curriculum and modified curriculum (with the Dynadjust) were observed for several, but different, biomechanical parameters of cervical and thoracic procedures. CONCLUSION: This project used a rehearsal program that provided quantitative feedback on an empirically defined schedule that was self-administered by the student. Results demonstrated significant changes in performance of spinal manipulation by students using the Dynadjust Instrument versus those who did not. Using quantitative feedback provided from training aids and biomechanical measurement systems, future training programs may be optimized and tested.

Developing skilled performance of lumbar spine manipulation.

OBJECTIVE: To quantify elements of spinal manipulation therapy performance and to test the strategy of combined rehearsal and quantitative feedback as a means of enhancing student skill development. DESIGN: Randomized, controlled study. SETTING: Chiropractic college. SUBJECTS: Thirty-nine chiropractic student volunteers entering the manipulation technique training course participated after providing informed consent. METHODS: Student performance of lumbar spinal manipulation therapy was quantified at the beginning, middle, and end of a trimester with a manipulation table imbedded with an AMTI force plate. Loads acting passing through the L5/S1 functional spinal unit were estimated by inverse dynamics. Participating students rehearsed the mamillary push, diversified procedure following either the standard curriculum alone or a modified curriculum adding a training aid as assigned on a randomized basis. Student's t and chi(2) tests were used to explore and describe biomechanical parameter changes over time as the semester progressed. RESULTS: Significant changes in performance between the standard curriculum and modified curriculum were observed in several biomechanical parameters. CONCLUSION: The reported project used a rehearsal program defined empirically and was self-administered in practice by the student. Results demonstrated significant changes in performance of spinal manipulation by students using the training aid instrument versus those who did not. With quantitative training aids and biomechanical measurement systems, future training programs may be optimized and tested.